EFFECTIVE HEALTHCARE TRANSITIONS, new payment
models, and quality outcomes are fast becoming a major focus
for long-term care (LTC) providers as part of the new shift to
value-based healthcare reform. The requirements are changing
the concept of “value” from the bestprice for the service to the
bestquality experience.

A skilled nursing facility (SNF) has indicators of quality called
“quality measures,” which are driven by regulation with clinical outcomes tied to reimbursement and reputation much
like acute care hospitals. The need for collecting and reporting clinical documentation has increased for SNFs because of
the expanded focus on quality performance, sustaining patient
outcomes across the healthcare spectrum, and participating in
Bundled Payment Care Initiatives (BPCI). 1

The myriad of changes with quality measures and BPCI requirements are beginning to impact the SNF administrators
and executive nursing staff who, historically, have been responsible for monitoring quality outcomes in long-term care. For example, National Healthcare Corporation (NHC), a top-ranked
provider of senior care, has made big changes to accommodate
this increased focus on documentation-driven quality reporting. NHC has turned to health information management (HIM)
professionals to help track, manage, and identify data needed to
support positive outcomes.

Many of NHC’s facilities in eastern Tennessee are preferred
providers within several large care networks, and they participate in the health information exchange East Tennessee Health
Information Network (etHIN) to enhance sharing of patient information during care transitions. Credentialed coding professionals are tasked with collecting and reporting patient data to
various entities within these care networks.

With changes to reimbursement methods, such as BPCI,shorter lengths of stay are built into designed clinical care plansfor specific diagnoses and surgical procedures. To demonstratethe provision of quality care for patients who only need short-term skilled nursing and rehabilitation services, the Centers forMedicare and Medicaid Services (CMS) recently added newmeasures which extend the scope of patient management be-yond the facility discharge. SNFs are now scored, ranked, andreimbursed based on outcomes which occur during and after apatient’s stay. Therefore, a successful facility’s work is no longerfinished when the patient goes home.NHC Farragut, an LLC within the overall corporation of NHCand located in Knoxville, TN, is a SNF with the unique feature ofbeing a high-volume skilled nursing and rehabilitation (rehab)facility with a small population of LTC patients. Uniquenesscan be challenging in this setting because most of the measuresused to calculate the quality ranking for a SNF are based solelyon LTC patient outcomes. Quality measures are calculated us-ing number of occurrences divided by total patients assessedin the period (i.e., two long-stay patients have a fall and thereare only 12 long-stay patients, then 2/12 x 100 = 16.67 percent).Quality care is questioned when almost 17 percent of a facility’slong-term patients suffer a fall. The measures outlined beloware scored using documentation from patients with episodesgreater than or equal to 101 days.In the list below, quality care is shown by lower percentageson each measure except those indicated with an asterisk—forthese measures, a higher percentage is better: 2 Percentage of residents experiencing one or more fallswith major injury Percentage of residents who report moderate to severe pain Percentage of high-risk residents with pressure ulcers Percentage of residents with a urinary tract infection Percentage of residents with a catheter inserted and left intheir bladder Percentage of residents who were physically restrained Percentage of residents whose need for help with daily ac-tivities increased Percentage of residents who received an antipsychotic